750205.pdf�. --
BUILDING DEPARTMENT
Applicant Fill
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PERMIT APPLICATION
Ineldo heavy Linos
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NAME (OR NAME OF BUSINESS)
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PERMISSIBLE ACTUAL
IAT COVERAGE LOT COVESiAOE
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MAILING ADDRESS
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PERMISSIBLE HEIOH'r/)�` PROPOSED HEIOHTQ
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CITY
TwELEPHONE NUMBN:IL
ACPU L T REA TOTAL HLDO. AREAS
sf�477c� 98 99
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RE UI E YAARS PROPOSED YARDS
NAME
FRONT 8IDE REAR FRONT SIDE REAR
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IF..,
LOT VARIANCE OR AL USE
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ADDRESSAT..
YES NO �4ER IT ER
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PLA PROVAL E:
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CITY
TELEPHONE NUMBER
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NAME
EXISTING 81%REET R/W FTDEFCIENCY TjiIB PROPERTY
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ANL A STiZLCL!%O� t 0.
COMP. PLAN ST. ft/W ....... �.FT ............FT.
REMARKS
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Driveway slopes not to exceed those
ADDRESS
indicated on Standard Dwg. No. 103
r°
W
TELEPHONE NUMBER
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METER SIZE
SERVICE SIZE
CLEARANCE
Y
CHECKED 8Y
STATE LICENSE NUMBER
CITY LICENSE NUMBER
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Legal D.scrlp[lon of Properly (Snow Below or Attach Four Coplee)-
REMARKS
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SEB ATINCH4b
TYPE CONNECTION VERIFIED BY
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StiP71 c TaNk 1e�-
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FERC. TESTPERMIT NUMBER
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REMARKO
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FIREEjZ7'ONE TYPE OF CONSTRUCTION STREET IMPROVED
ZV_ J7_ - /U/ UTgS [I NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
CK
❑ GAB
❑ YES •70
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NEW
[LSTDENTIAL
LINE
PLAN US&, LED ➢Y THIS SITE IS LOCATED IN THE CITY
N -RESIDENTIAL
❑ SIGN
EDMONDS. 5ALE5 TAX
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❑ ADD
RETAINING
=-4 SHOULD BE CODED 31.0LOCAL4OF
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❑ DEMOLISH WALL
❑
❑ ALTER EXCAVATE FENCE
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OR FILL (......... .x .......... Ft.)
❑ ❑
❑ ElSWIAI
❑ REPAIR N1ehtOVE POOL
n ti s
NUMBER OF STORIES NUMBER OF
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DWELLING /
O UNITS
NATURn WORK TO NE
Valuation
Fee Receipt No.
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t.iG/t.tJ e�
Plan Check Na.....................
�Or
BUILDING -
3L O -S ce -ny
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PROPOSED USE
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PLUMBING
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PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT &GAS LINE
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FENCE
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BICN
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tRETAINING
WALL
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N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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1 hereby acknowledge that I have read this apDllcntlon; that the In.
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fnrmatlon Elven Is correct; and that I am the owner, or the duly author -
Hud agent of the owner. I agree to comply with city and .late laws ngu•
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no person
will be employed In vlolatloa of the Labor Code of the Stale of Washington
THIS PER511T
This application is not a permit until
relating to Workmen'. Compensation Insurance.
AUTHORIZER
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORM NOTED
uty; and fees are paid, and receipt Is ac -
.hall be ...plated In ninety days; MOVED -IN BUILDINGS .hall be com.
Imowledged in space provided.
pleted In six month..)
NATURE Q (OWNER OR AGENT) DATE SIGNED
INSPECTION
1RR' SIGNATURE
DEPAI[TMENT
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CITY OF
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EIDAZONDS
NOTE: Applicant Subject to Plat Check Fee
775.2525
This PC raft covers ivork In Ile done .n private property ONLY.
Any construction on the public dontaln (curbs, sidewalks, driveway.,
marquee., ale.) will regwre separate Dermis.lon.
FILE
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BUILDING DEPARTMENT Applicant FLU
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ZONE �_ ,'/} NUMBER_ J
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Inside Heavy Line.
PERMIT APPLICATION
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ADDRESS / / •�_ / Z<I,
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NAME ON BV81NEe8)
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NAME (OR
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AU 4'1'11,
PERMISSIBLE r ACTUAL r
LOT COVERAGES _ ! LOT COVERAGE
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MAILING ADDRESS
PERMISSIBLE HEIGIIT PROPOSED HEIGHT
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CITY
TELEPHONE NUMHEK
ACTU L L T AREA TOTAL BLDG. AREA
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x
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IREO'YARKD9 PROPOSED YARD.
NAME
FRONT SIDE REAR FRONT BIDE REAR
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Y
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CAL LO'f VARIA OR C AL USE
F
ADDRESS
q YES NO YEART
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UPLA
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NI' G- . A. ROYAL / ,
CITY
TELEPHONE NUMBER
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STRE ET'R/IV
EXISTING STREET A/W _�`!�t4.FT. / DEFTCiENCY T 19 PROPERTY
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NAME
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et
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COMP. PLAN ST. R/N ...d...QF7'./ ...FT.
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ADDRESS
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CITY TELEPHONE NUMBER
( CHECKED BY
ii?/tial.
6ERVICE BI2E CLEARANCE
CHECKED HY
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OMETER
STATE LICENSE NUMBER
111Y LICENSENUMBEHL
-sl'LE
I
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REMARKS -11
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Legal Description of Property (Show Below or Attach Four Copies)
(%i/h/% li
TYPE CONNECTION VERIFIED BY
PERC. TEST PERMIT NUMBER
d. -
se
;t31
w
se
REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
.L Y. I �% .. I✓ 4�yEs 0 NO
S G _ / !_
v vGAII
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
RESIDENTIAL
LINE
C] YES Q.NO
q NEW
PLAN CHECKED DY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
i
NON-RESIDENTIAL
SIGN
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1" `71, /
� ! •l.fit,c. J SHOULD BE CODED 31.04.
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ADD ❑ RETAINING
❑ WALL'
iRE ARKS)
DEMOLISH
ALTER ❑ EXCAVATE FENCE
OR FILL L.......... x .......... Ft.)
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El REPAIR PRE-DIOVE' D SWIM
INSP. POOL
T /?'J 0/2"
i
NUMBER OF STORIE. NUMDER OF
DWELLING '
UNITS
NATURE_,OF WORK TOBjrPNE ,
f( A
Valuation
Fee Receipt No.
Plan Check No .....................
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BUILDING
77
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PROPOSED USE
PLUMBING
I
O !
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT k GAB LINE
U
PENCE
i
SIGN
RETAINING WALL
N
SWIMMING POOL
I
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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I hereby sok—Urig. that I b. -read this appileo.U. that the In-
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correct; and that I am the owner, or the duly author-
formallon givens
Ized agent of the Owner. I agree to comply with city and state laws regu-
ATTENTION
APPLICATION APPROVAL
lacing ..., cellon; and In doing the work authorized thereby, no parson
'
will be employed In An site. of the Labor Code of the Slate of Washington
THUS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep.
NOTE: Permit limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
utyi and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVED -1N BUILDINGS shall be nom-
knowledged in apace provided.
pitted In six months.)
SIGNATURE (OWNER Oil AGENT) DATE SIGNED
INSPECTIONDIRE
CTQR'B, SIG NATURE /(
DEPARTMENT
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I �
CITY OF
EDbfOND$
ATL_
----_..-
NOTE: Applicant Subject to Pfau Check Fee
C _. '7
775.2525
Thl. Permit eo n work m bo done on prlante pro perry ONLY.
Any conetruell..... the public domoin drh' eye,
INSPECTOR
ecarat, permissio
nuueueee, etc.) w'lll reeulre separate permission.
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